| NPI | 1912153107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 8595) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 8595) |
| 101YM0800X Counselor, Mental Health (Licence: NC 8595) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2011-08-08 |